Many who need surgery after a broken bone are given thrombosis preventative injections. They contain heparin, which prevents blood clots from forming by stopping blood clotting. A recent study in the United States, published in the New England Journal of Medicine, now shows that aspirin may be as effective in preventing thrombosis as heparin. More than 12,000 people who had to have surgery for a broken bone were examined.
Under current guidelines, one group of study participants received heparin injections twice daily after the operation, and the other group received aspirin twice daily. The researchers found that aspirin was not inferior to heparin in preventing death in people with bone fractures. They also saw no difference in clots in the lungs (pulmonary embolism). The frequency of bleeding complications, infections, wound problems and other adverse events was also similar in both study groups.
Benefits of Aspirin
In general, patients with broken bones that require surgery are at an increased risk of blood clots forming in the lungs and limbs. Large clots, such as those in the lungs, can be fatal.
However, current guidelines recommend only prescribing heparin as an injection – although previous studies have shown aspirin to have an effect. “Previous guidelines do not classify aspirin as prophylaxis of thrombosis in this group of patients. However, aspirin is cheaper and offers significant adherence advantages due to the possibility of taking it in pills”, says Jorg HeckenkampPresident of the German Society for Vascular Surgery and Vascular Medicine.
According to Heckenkamp, both drugs are “equal” after bone fracture operations. “However, in this work, the occurrence of deep vein thrombosis without fatal complications was more frequent in the aspirin group. The safety risks associated with the administration of aspirin were not described”, says Heckenkamp. According to the vascular surgeon, the data “will likely find its way into the next guidelines for thrombosis prophylaxis”.
criticism
Robert Klamroth, chief physician at the center for vascular medicine at Clínica Vivantes in Friedrichshain, Berlin, takes a more critical view of the study. According to Klamroth, the people included in the study showed differences regarding the individual risk of thrombosis after bone fracture. Furthermore, a study last year showed that heparin is “superior to aspirin in prophylaxis of thrombosis after surgery.”
Klamroth assumes that aspirin has little effect in preventing venous thrombosis after surgical interventions for bone fractures. However, patients at high risk of venous thrombosis would benefit less from aspirin than from heparin.
“So my conclusion, also with a view to publishing the current data, is that aspirin may not be sufficient in individual cases, depending on the patient’s individual risk of thrombosis,” Klamroth said.